R E S E A R C H A R T I C L E I n j u r y S u r v e i l l a n c e i n T a e k w o n d o a n d Ju d o D u r i n g P h y s i o t h e r a p y C o v e r a g e o f t h e S e v e n t h A l l A f r i c a G a m e s A B STR A C T: Objective: To obtain data relating to the incidence o f injuries sustained during taekwondo a n d ju d o com petitions at the 7th A ll A frica Games. M ethods: Prospective recording o f injuries sustained by athletes who sought physiotherapy services at the games. D etails o f type o f injury, injury sites an d injury severity were obtained. R esults: Seventy athletes out o f 390 participants reported injuries. The overall injury risk ratio was 0.18. Injuries reported were strains/sprains (65,6%), bruises/contusions (16.1% ) and dislocations o r fra ctu res (12,9%). The upper limbs were more com monly injured. O f the injuries sustained, approxim ately 18%, 69% an d 13% were respectively classified as mild, m oderate an d severe injuries. Conclusions: The high incidence o f moderate to severe injuries highlights the need f o r injury prevention program s a n d the presence o f m edical s ta ff at m ajor tournam ents in order to m ake early diagnosis and appropriate intervention. K E Y WORDS: TAEKWONDO; JUDO; INJURIES, PHYSIOTHERAPY, SU RVEILLAN C E PHILLIPS JS, BSc'; FRANTZ J M \ MSc; AMOSUN SL, PhD'; WEITZ W 2 1 Department of Physiotherapy, University of the Western Cape Sparts Science Institute of South Africa INTRODUCTION Taekw ondo is a type o f fighting system that o rig in ated in K orea and that em ploys kicking, punching and various evasive techniques. Judo on the other hand em phasizes grappling techniques, especially those that upset the oppo­ n e n t’s balance, in particu lar gaining leverage, throw s, clothes grabbing, jo in t locks and stran g le holds (E n carta encyclopedia). In 1994, taekw ondo, as propagated by the W orld Taekwondo F ed eratio n , w as rec o g n ize d by the International O lym pic C om m ittee as a spo rt to be included in the reg u lar O lym pic gam es starting from 2000 in Sydney, Australia (Pieter and Zem per, 1997a & b). Judo had already gained O lym pic status in 1964. T he All A frica G am es is one o f the four largest m ulti-sport events in the C O RRESPO ND EN C E TO: M rs JS Phillips D epartm ent o f Physiotherapy U niversity o f the W estern Cape Private Bag x l7 Bellville 7535 Tel: 27 21 9592542 Fax: 27 21 9592804 Email: jphillips@ uw c.ac.za world. In the first All A frica Games held in B razzaville, C ongo in 1965, over 2500 athletes participated in 10 sporting codes in w hich 30 independent African states w ere represented. T he 7th All A frica G am es (A A G ) w as held in G reater Johannesburg, South A frica, in Septem ber 1999, and saw the conver­ gence o f approxim ately 6500 athletes and officials from 52 African countries taking part in 17 sporting codes. The participants in both ju d o and taekw ondo were from 27 A frican countries. Injuries seem to be an unavoidable part o f any athletic activity and Asian m artial arts is no exception (Pieter and Van Ryssegem , 1998). Injuries are espe­ cially prevalent in contact sports such as full-contact taekw ondo or full-contact karate. However, prospective epidem io­ logical studies on injuries in young athletes’ participation in m artial sports in general are scarce (Pieter and Zem per, 1997b; Pieter et al, 1998). D espite the popularity o f these sports at the Olym pic and All A frica G am es, little is known about the injury profiles o f the athletes com peting at these gam es. A lthough the m artial arts are generally practised in a safe environm ent, they are reputed to be a high-risk activity (Burks and Salterfield, 1998). The injury rate is reported to com pare favourably with other m ainstream sports, and martial arts are even considered probably safer than m ost. In a prospective study to determ ine the incidence o f head and neck injuries in young taekw ondo athletes, it was found that contusion was the m ost frequently occurring injury type for both girls and boys and that the m ajor injury m echanism was receiving a blow (Yam am oto and K igaw a, 1993). In view o f the paucity o f data during taekw ando and ju d o com petitions, par­ ticularly in A frica, the main purpose of this study was to obtain data relating to the incidence and degree o f severity o f injuries sustained by athletes who took part in taekw ondo and ju d o com pe­ titions at the 7th AAG, and sought physiotherapy services provided at the gam es venues. In addition, the study also aim ed at determ ining the injury risk ratio and the injury rates in terms o f athlete exposure. METHODS T he m edical com m ittee for the game identified different team s o f health care professionals to provide m edical cover­ age at various com petition venues. There w ere team s o f doctors, physiotherapists, nurses, m asseurs and St Jo h n ’s First Aid staff. M edical clinics were set up at the venues w here the events took place. 32 SA J o u r n a l o f P h y s io th e ra p y 2001 V o l 57 No 1 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) mailto:jphillips@uwc.ac.za TABLE 3. Types of Injuries sustained (n=93) Judo Taekwondo Strains/sprains 45 17 Bruises/contusions 5 10 Dislocations/Fractures 8 4 Others 4 0 TABLE 4 . Distribution of injuries by body part (n=93) Sport Upper Limb Lower Limb Trunk Head Judo 32 (51.6%) 19 (30.6%) 9 (14.5%) 2 (3.2%) Taekwondo 10 (32.3%) 19(61.3% ) 1(3.2%) 1(3.2%) TABLE 1. Injury data for taekwando competition Number of: Athletes 80 Matches/bouts 179 Athlete-exposures to the possibility o f being injured (2 per match) 358 Reported injuries 31 Total injury rates Per 1000 athlete-exposures (A-E) 86.6 TABLE 2. Injury data for judo competition Number of: Athletes 310 Matches/bouts 309 Athlete-exposures to the possibility o f being injured (2 per match) 618 Reported injuries 62 Total injury rates Per 1000 athlete-exposures (A-E) 100.3 Injured athletes were initially assessed by m edical staff at the ringside or in training areas, and were referred to the m edical clinics for additional attention or further referral. Physiotherapists were based in the m edical centres at the venues for taekw ando and judo, and assessed all referred athletes in order to classify the injuries as mild, m oderate or severe. An injury was defined as any incident occurring during warm -up or com pe­ tition w hich required medical attention. Injuries were graded as mild, m oderate o r sev ere based on the treatm en t required and the outcom e o f the injury (Z em per and Pieter, 1989). M ild injuries required first aid treatm ent only, such as ice and bandaging, and athletes were able to com pete in their next match. M oderate injuries necessitated m anage­ m ent such as m edication, physiotherapy (e.g. ultrasound, interferential, soft tissue mobilization), immobilization, or required a com petitor to miss the next match. Severe injuries required referral to the hospital resulting in prolonged im m o­ bilization, effectively ruling the com pe­ titor out o f the com petition for the rest o f the gam es. The match doctor later confirm ed injuries assessed and classi­ fied by the physiotherapist, and the physiotherapist who assessed the injured athlete com pleted the data capture sheet. All m atches were single elim ination com petitions. Injury data were recorded on a data capture sheet that was sim ilar to the one used at the 6th AAG in Zimbabwe. Information gathered included the bio-dem ographic data o f the athlete, and the history, assessm ent and m anage­ ment o f the injury. The overall num ber o f athletes who participated in taekwando and ju d o was 390, o f w hich 210 athletes (121 m ales, 89 fem ales) participated in judo. One hundred and eighty athletes (101 m ales, 79 fem ales) participated in taekwando. T he injury risk ratio was determ ined by the num ber o f injured athletes per num ber o f participants. Exposure data for calculating injury rates were gathered from records o f bouts actually fought. Each bout consisted o f three rounds o f three m inutes each. Injury rates were calculated from the total number of actual m atches fought and the total tim e (in m inutes) fo r w hich ath letes w ere exposed to the possibility o f sustaining an injury (Zem per and Pieter, 1989), using the formula: (num ber o f injuries/ num ber o f athlete-exposures) x 1000 = num ber o f injuries per 1000 m inutes o f exposure. One athlete-exposure (A-E) referred to one individual com peting in one bout w here he/she was exposed to the possibility o f being injured. Because there are always two people com peting in any one bout, there are two A-Es per bout. RESULTS Seventy athletes were injured in taek­ wondo and judo events (N=390), giving an ov erall risk ratio o f 0.18. Jud o accounted for 43 injured athletes and taekw ondo accounted for 27 injured athletes. T he injury risk ratio s for ju d o and taekw ondo were 0.2 and 0.15 respectively. T he sum m aries o f the exposure and injury rates data for taek­ w ando and ju d o are presented in Tables 1 and 2 respectively. D uring the tournam ent, a total o f 93 injuries were reported o f which judo accounted for 62 injuries and taekwondo 31 injuries. T he in juries sustained included strains and sprains (65.6% ), bruises and contusions (16.1% ), dislo­ catio n s (7.5% ) and fractu res 5.4% (Table 3). The distribution o f injuries by body part is presented in Table 4. These areas were further classified into the follow ing regions: shoulder (17%), h and (17% ), w rist (10 .7% ), ankle SA J o u r n a l o f P h y s io th e ra p y 2001 V o l 57 No 1 33 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) (10 .8% ), lo w er leg (10 .8% ), trunk (10.8% ), knee (7.5% ), foot (1.2% ) and head (3.2% ). Injuries to other parts such as elbow and forearm , accounted for 11%. O f the injuries sustained, 18.1% was classified as mild, 69% as m oderate and 12.9% as severe injuries. DISCUSSION W hen large num bers o f athletes com pete intensely over a short period o f tim e, a variety o f injuries are often encountered. Thus, safety in sport has becom e an issue o f concern as injuries seem to be an unavoidable part o f any athletic activity, and A sian m artial sports are no exception. T he cost o f injuries to individuals is significant. It becom es increasingly significant w hen the indi­ vidual participates at national and inter­ national levels, as it affects not only the individual but the team and the country. U nfortunately, no inform ation is avail­ able regarding injuries in m artial arts in South Africa. T he overall injury risk ratio for this study was 0.18. This was sim ilar to stu­ dies o f other sports such as athletics that indicated an injury risk ratio o f 0.22 during com petition (Bennell and Crossley, 1996). This supports the opi­ nion that the injury rate in m artial arts com pares favourably w ith other sports. H ow ever w ith the logistical set up at the gam es’ venues, it w as possible that there w ere som e injured athletes who did not report to the m edical center to receive physiotherapy. Som e o f the participating countries cam e w ith team physiothera­ pists who had the sole responsibility o f treating their athletes. In addition, there w ere few cases w hich the m atch doctors considered very severe, and were referred directly to nearby hospitals. T herefore there is a possibility that the injury risk ratio could be higher than 0.18. In addition, Z em per and Pieter (1989) reported that about 60% o f m artial arts injuries sustained during com petition are not reported. This was due to (i) athletes considering injuries to be minor, (ii) ath­ letes thinking that they were indispensable, and (iii) the instructor/coach refusing to accept that the athlete was injured. If sim ilar reasons for not reporting injuries at com petition w ere prevalent during the 7th All A frica G am es, the injury risk ratio could be higher than w hat has been reported. However, the total injury rate reported for taekw ando in this study (86.6/1000 athlete-exposure) com pares favourably w ith the rates reported by Pieter and Z em per (1997c) for ju n io r ath letes (9 5 .1 /1 0 0 0 ath lete-ex p o su re) and senior athletes (105.5/1000 athlete- exposure). U nfortunately, sim ilar com ­ parison w as not possible for judo. Injuries sustained at the 7th All A frica G am es included strains and sprains, bruises and contusions, and fractures and dislocations. The m ost frequently occurring types o f injury were strains and sprains. This was in contrast to ear­ lier studies in w hich contusions were identified as the m ost frequently occur­ ring injury types (Z em per and Pieter, 1989; Yamamoto and K igaw a, 1993). A pproxim ately 13% o f the injuries sustained w ere dislocations and frac­ tures. This supports the need for injury prevention program m es and the im por­ tance o f p ro te c tiv e gear. T he high incidence o f closed soft tissue injuries (65.6% ) highlights the need to have medical staff at m ajor tournam ents in order to establish an early diagnosis, with the intention o f preventing further injury. E arly in terv en tio n to treat inflam m ation, pain and lim ited range o f m otion will ensure that the athlete can return to com petition as soon as possible (Seto and Brewster, 1993). The need for injury prevention program m es is further highlighted by the large percentage o f m oderate to severe injuries reported in the study. They are referred to as time- loss injuries (Pieter and Zem per, 1997b) since injured athletes are prevented from continuing w ith ongoing bouts and/or subsequent bouts, and prevented from returning to practice or com petition for at least one day. CONCLUSION This study identified that m ost o f the injuries sustained in taekw ondo and ju d o during the 7th A A G were m oderate to severe (82% ). This justifies the need for availability o f m edical services at sporting events involving m artial arts. The high incidence o f injuries sustained during the gam es, if not controlled, m ay adversely affect the developm ent of martial arts in Africa. B urks J.B , S alte rfield K 1998 F o o t and ankle injuries am ong m artial artists. R esults o f a survey. Journal A m erican Podiatric M edical A ssociation 88: 268-278 B ennell K, C rossley K 1996 M usculoskeletal In ju rie s in T ra c k a n d F ield : In c id e n c e , D istrib u tio n an d R isk F a cto rs. 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